Eight thousand Spanish men and women over 20 years old will undergo ultrasound scans of their femoral arteries (in the groin) and carotid arteries (in the neck) as part of the REACT research project, which will study how cardiovascular diseases begin in young adults. The project, funded with 23 million euros by the Novo Nordisk Foundation and led in Spain by the National Center for Cardiovascular Research (CNIC), aims to change the strategy for preventing strokes and heart attacks.

“At this time we treat risk factors such as hypertension or high cholesterol. But we have discovered that cardiovascular disease begins before these treatments are given. We believe that we should treat those who have the disease, rather than focusing on risk factors. We want to change the paradigm,” states Borja Ibáñez, scientific director of the CNIC and coordinator of the REACT project in Spain.

It has been another CNIC study, the PESA project led by cardiologist Valentín Fuster, that has revealed that approximately two-thirds of adults aged between 40 and 55 have undiagnosed atherosclerosis, with abnormal accumulations of cholesterol in the arteries. When the latest PESA results were presented last December, some cardiologists already advocated for improving early detection and starting treatment sooner.

The Novo Nordisk Foundation, the world’s largest philanthropic foundation, contacted the CNIC two years ago to design a transformative proposal on cardiovascular prevention, as reported by Borja Ibáñez. The approved proposal, announced today, is an eight-year project that will be co-led by the CNIC in Spain and the Rigshospitalet at the University Hospital of Copenhagen in Denmark, the home country of the Novo Nordisk Foundation.

For the first two and a half years, until the end of 2026, an investment of 23 million euros is planned, which will allow studying 8,000 people in Spain and the same number in Denmark. The participants, half men and half women, aged between 20 and 70, will undergo ultrasounds of the carotid and femoral arteries, which will reveal if they have atherosclerosis and to what extent. Additionally, half of them will undergo a coronary artery angiography to assess the relationship between the state of the heart arteries and the peripheral arteries.

If atherosclerosis is detected, participants will be assisted in adopting healthier habits, which will include dietary recommendations and physical activity. In cases where it is deemed appropriate, these recommendations will be complemented with medication, such as for hypertension or high cholesterol.

“We do not want to have the entire population on treatment for life,” warns Borja Ibáñez, who is also a cardiologist at the Jiménez Díaz Foundation Hospital in Madrid. “Our hypothesis is that a period of treatment may be sufficient for the disease to remit. Instead of increasing the volume of population being treated, it could even be reduced.”

This hypothesis stems from the results of the PESA study, in which more than 4,000 Banco Santander employees participated. The study revealed that atherosclerosis is not a progressive irreversible disease as previously believed, but rather can regress in some individuals. However, the chances of regression are higher in young, non-smoking individuals with normal cholesterol levels. Hence, the concept that the disease can be cured if detected early, but will require chronic treatment if diagnosed in its advanced stages.

The extension of the REACT project until 2032, with an additional investment from the Novo Nordisk Foundation that has not yet been announced, will allow for long-term follow-up of the participants to verify if, as researchers hope, early detection allows for the cure of cardiovascular disease.